C.A.R. Form FLD, Lead-Based Paint and Lead-Based Paint Hazards Disclosure, Acknowledgment and Addendum (Revised 11/10) Completed Form Examples and Samples
Explore a comprehensive example of a filled-out C.A.R. Form FLD, the Lead-Based Paint Disclosure for California. This sample provides a clear guide on how to correctly complete the form for properties built before 1978, including seller disclosures, buyer acknowledgments, and agent certifications. Ideal for buyers, sellers, and real estate agents.
C.A.R. Form FLD Example – Seller Disclosure of Known Lead Paint
How this form was filled:
This is a sample of a filled-out C.A.R. Form FLD for a property built before 1978 where the seller has knowledge of lead-based paint and provides an existing report. The seller checks box A(1)(a) to disclose knowledge and lists the available report. The buyer acknowledges receipt of the report and the EPA pamphlet, and initials to waive the 10-day inspection period. All parties, including agents, have signed and dated the form correctly.
Information used to fill out the document:
- Property Address: 123 Maple Avenue, Sunnyvale, CA 91234
- Date of Purchase Agreement: March 15, 2026
- Seller(s): John Smith, Jane Smith
- Buyer(s): Michael Johnson, Emily Johnson
- Seller's Disclosure of Knowledge (Section A(1)): Seller has knowledge of lead-based paint and/or lead-based paint hazards. (Initialed by Sellers)
- Seller's Provided Reports (Section A(2)): Seller has provided the Buyer with the following report: 'Report on Lead Paint Inspection' dated 06/05/2015. (Initialed by Sellers)
- Buyer's Acknowledgment of Receipt (Section B): Buyer has received copies of all information listed in A above and the pamphlet 'Protect Your Family from Lead in Your Home.' (Initialed by Buyers)
- Buyer's Inspection Right (Section C): Buyer has waived the opportunity to conduct a risk assessment or inspection. (Initialed by Buyers)
- Agent's Acknowledgment (Section D): Agent has informed the Seller of the Seller's obligations and is aware of his/her responsibility to ensure compliance. (Initialed by Seller's Agent and Buyer's Agent)
- Certification of Accuracy: Signed by all Sellers, Buyers, and Agents.
- Sellers' Signatures and Date: John Smith, Jane Smith on 03/15/2026
- Buyers' Signatures and Date: Michael Johnson, Emily Johnson on 03/16/2026
- Seller's Agent Signature and Date: Susan Davis on 03/15/2026
- Buyer's Agent Signature and Date: Robert Brown on 03/16/2026
What this filled form sample shows:
- Correct identification of a pre-1978 property which triggers the lead disclosure requirement.
- Proper completion of the Seller's Disclosure section, indicating known lead-based paint and listing available reports.
- Accurate Buyer's Acknowledgment, confirming receipt of disclosures and the federal pamphlet.
- Clear indication of the Buyer's waiver of the 10-day inspection period, a common choice in competitive markets.
- Completed Agent's Acknowledgment and Certification of Accuracy with all required signatures and dates, ensuring full compliance.
Form specifications and details:
| Form Name: | C.A.R. Form FLD, Lead-Based Paint and Lead-Based Paint Hazards Disclosure, Acknowledgment and Addendum |
| Revision Date: | 11/10 |
| Use Case: | Sale of a pre-1978 residential property with seller's knowledge of lead-based paint and provision of existing reports. |
| Categories: | disclosure forms |
| Created: | February 05, 2026 08:05 PM |